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common injuries - hip

Hip Arthritis

Description
The hip is a 'ball and socket' joint. The ends of the ball (femoral head) and the socket (acetabulum) are normally covered with a layer of smooth cartilage. If the cartilage wears out, bone will rub on bone, resulting in a stiff and painful arthritic hip.
Common Causes
Most hip arthritis is genetic, with a family predisposition. It is probably not activity related, and in fact activity may be helpful in reducing the risk of arthritis.
Symptoms
Pain when walking. Difficulty tying your shoes, or putting on socks. Difficulty with stairs, getting in and out of cars. The pain is usually felt in the groin area.
Physical Findings
Decreased range of motion of the hip, with pain on extremes of motion.
Workup
History, physical examination, and x-rays are diagnostic. X-rays show loss of hip joint space due to cartilage wear, bone spurs, and cysts. Ruling out other causes of hip pain is required.
Non-Operative Treatment
Weight control, continuing activity, anti-inflammatory medication, and the use of a cane or walker.
Anti-Inflammatory Medication(hide)

Non-Steroidal Anti-Inflammatory Medication (NSAIDS) have become one of the most popular medications in the world. There are many different NSAIDS, at least twenty in the U.S., but they are all related to each other. Unlike corticosteroids, these medications block inflammation by a different pathway. They are effective in reducing the pain and swelling associated with many orthopaedic conditions.

Aspirin was the first NSAID. Ibuprofen (Motrin, Advil, Nuprin) is by far the most popular. Other NSAIDS have become available for over the counter use (Aleve, Orudis) recently, and you can expect many more to be available soon. Generally, the over-the-counter medication is identical to the prescribed medication, but is a smaller dose. There are once a day NSAIDS (Relafen, Daypro, Orudis and others) that are more convenient to take.

All medications have side effects, and the most common side effect from NSAIDS is stomach or gastrointestinal upset. Therefore, NSAIDS should be taken with food, and discontinued if abdominal pain persists. Another side effect of NSAIDS is interfering in the normal blood clotting mechanism. Patients on chronic NSAID use may notice easy bruisability, bleeding gums, or other signs of 'thinned blood'.

Recently, a new type of NSAID has been developed. All of the previous NSAIDS have worked by interfering with the 'COX1' enzyme. Unfortunately, COX1 is also involved is protecting the stomach, the blood coagulation process, and many other important bodily functions. The COX2 enzyme is specific for inflammation, and COX2 inhibitors (Celebrex, Vioxx) were recently approved by the FDA. Other COX2 inhibitors are expected soon. The advantage of these new medications is that they do not bother the stomach, can be taken without food, and do not interfere in the clotting process.

Every person responds differently to NSAIDS. Some people respond to most of them, and for other people only a few different NSAIDS may work. If an NSAID is ineffective, have your doctor change you to one in a different class.

Surgical Treatment
Total Hip Replacement (total hip arthroplasty).
Comments

High success rate, and great patient satisfaction for joint replacement. Biggest problem is durability of the prosthesis, which wears out or loosens with time. The success rate for a redo, or revision hip replacement is not nearly so high. Therefore, this surgery should be delayed as much as possible, especially in the younger patient.

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Greater Trochanteric Bursitis/ Hip Bursitis

Description
The outside of the hip bone (femur) has a layer of slippery, filmy tissue called the bursa. This allows sliding of thigh muscles over the outside of the hip. When this bursa becomes inflamed, bursitis (or inflammation of the bursa) results.
Common Causes
Overuse, change in running or other sport techniques (hills, increase in distance, etc.). recent weight gain.
Symptoms
Pain in the outside of the hip, often radiating down the outside of the thigh to and past the knee. Worsened with activity.
Physical Findings
Tenderness directly over the greater trochanteric bursa. Pain with certain provocative tests and maneuvers.
Workup
Diagnosis is based on history and physical examination. Workup is directed towards ruling out other causes, such as arthritis, or nerve irritation.
Non-Operative Treatment
Rest, physical therapy, and anti-inflammatory medication are very helpful. A trial of a corticosteroid injection into the bursa is often of great benefit. Avoiding the irritating activity, or modifying sport technique is also necessary.
Anti-Inflammatory Medication(hide)

Non-Steroidal Anti-Inflammatory Medication (NSAIDS) have become one of the most popular medications in the world. There are many different NSAIDS, at least twenty in the U.S., but they are all related to each other. Unlike corticosteroids, these medications block inflammation by a different pathway. They are effective in reducing the pain and swelling associated with many orthopaedic conditions.

Aspirin was the first NSAID. Ibuprofen (Motrin, Advil, Nuprin) is by far the most popular. Other NSAIDS have become available for over the counter use (Aleve, Orudis) recently, and you can expect many more to be available soon. Generally, the over-the-counter medication is identical to the prescribed medication, but is a smaller dose. There are once a day NSAIDS (Relafen, Daypro, Orudis and others) that are more convenient to take.

All medications have side effects, and the most common side effect from NSAIDS is stomach or gastrointestinal upset. Therefore, NSAIDS should be taken with food, and discontinued if abdominal pain persists. Another side effect of NSAIDS is interfering in the normal blood clotting mechanism. Patients on chronic NSAID use may notice easy bruisability, bleeding gums, or other signs of 'thinned blood'.

Recently, a new type of NSAID has been developed. All of the previous NSAIDS have worked by interfering with the 'COX1' enzyme. Unfortunately, COX1 is also involved is protecting the stomach, the blood coagulation process, and many other important bodily functions. The COX2 enzyme is specific for inflammation, and COX2 inhibitors (Celebrex, Vioxx) were recently approved by the FDA. Other COX2 inhibitors are expected soon. The advantage of these new medications is that they do not bother the stomach, can be taken without food, and do not interfere in the clotting process.

Every person responds differently to NSAIDS. Some people respond to most of them, and for other people only a few different NSAIDS may work. If an NSAID is ineffective, have your doctor change you to one in a different class.

Corticosteroids ("cortisone")(hide)

Key words: cortisone, corticosteroid, Medrol

Corticosteroids are a family of medication. There are many different corticosteroids that naturally occur in the body, and are also available as oral or injectable medication. The most famous, 'cortisone', is actually not in use anymore, and has been replaced by more effective medications.

Corticosteroids have significant value in the treatment of many Orthopaedic conditions. Corticosteroids are potent anti-inflammatory medicines. They reduce the bodies 'inflammatory response' to injury. Signs of inflammation may be swelling, pain, warmth, and stiffness. While these are normal responses by the body to injury, and are essential in the normal healing process, the inflammation itself can, at times, slow down the recovery process. By giving a patient a corticosteroid, the body's own inflammatory response to an injury is decreased.

This means that corticosteroids can reduce some of the symptoms following an injury, especially swelling and pain. This can be helpful if the swelling and pain are interfering with recovery. The corticosteroid mediation itself usually doesn't heal an injury; it just allows the body to do it with fewer symptoms. One must be careful about using corticosteroids to simply mask symptoms. This may be appropriate is the diagnosis is known, and there are no other good options. If masking symptoms will make a condition worse, or harder to treat later on, then their use is inappropriate. It's as if your car was making a loud noise from the engine. Corticosteroids are like turning up the radio and rolling up the window: you just don't hear it. Now if you know what's wrong, and there's not much to do, then that is appropriate. If you don't know what's wrong, you might be making things worse.

Corticosteroids, like all medication, have side effects. Injections may be painful for a day or two. In dark skinned individuals, a corticosteroid injection can rarely cause a small area of skin lightening, or depigmentation. Corticosteroid injections are contraindicated in certain areas of the body, like the Achilles tendon, where it can actually cause rupture of the tendon. Regardless of location, repeated multiple corticosteroid injections are probably not a good idea. Nevertheless, used appropriately, corticosteroids can be extremely effective in treating certain conditions.

Surgical Treatment
Open bursectomy.
Comments
Surgery is almost never required for this condition. Most cases can be treated non-operatively, but may take a lot of time and patience.